AB0815 SLEEP DISORDERS ARE FREQUENT IN SPONDYLOARTHRITIS, ASSOCIATED WITH REDUCED QUALITY OF LIFE AND DEPRESSION AND MORE PREVALENT IN FEMALE PATIENTS
Authors: N. Frede, E. Rieger, R. Lorenzetti, A. Venhoff, C. Hentze, I. Jandova, C. Glaser, J. Thiel, R. Voll, N. Venhoff
Journal: Annals of the Rheumatic Diseases (2022)

Background Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) may have a profound impact on health-related quality of life (HRQoL) and sleep despite effective treatment. Objectives To assess sleep and HRQoL in SpA and determine associated factors. Methods Monocentric questionnaire-based assessment of HRQoL, function, sleep and depression in 314 SpA patients (n=168 PsA, n=146 axSpA). Results Under effective treatment 138 SpA patients (46.5%) demonstrated abnormal sleep behaviour. 49.3% reported not being able to sleep through the night, with 6.1 % needing sleeping pills. 11.9% indicated feeling unrefreshed most mornings. Abnormal sleep behaviour was associated with female sex (p=0.005), HLAB27 (p=0.034), functional impairment (p=0.001) and depression (p&lt;0.001). Patients reporting unrestful sleep had significantly more depressive symptoms (p&lt;0.001) and highly reduced physical and mental HRQoL (p&lt;0.001). Satisfaction with health was rated significantly lower (p&lt;0.001). Patients with axial involvement (axSpA/axPsA) reported worse sleep quality (p=0.002) and waking too early (p=0.038) despite 73.7% receiving biologics. Sleep quality and early awakening correlated with BASDAI (p&lt;0.001). Smokers had a reduced HRQoL (p=0.018) despite younger age (p=0.008). Female patients had worse sleep quality (p&lt;0.001), needing more time to fall asleep (p=0.022), not being able to sleep through the night (p=0.026) and feeling unrefreshed in the morning (p&lt;0.001). They had a reduced physical (p=0.019) and mental HRQoL (p=0.003), more depressive symptoms (p=0.040) and lower functional capacity (p=0.002). Functional capacity was associated with younger age (p&lt;0.001), sex (p=0.042), smoking (p=0.008), sleep quality (p&lt;0.001) and depression (p&lt;0.001). 66.2% of patients have been assessed longitudinally, before and 3y later during COVID19 pandemic. Physical and mental HRQoL were stable over time. Functional capacity had decreased slightly. Subjective QoL during the COVID19 pandemic was not reduced compared to before. Regarding depressive symptoms, there was a mild but significant improvement over time (p=0.019). Furthermore, we observed an improvement of environmental QoL (p=0.034) during COVID pandemic. Overall subjective QoL as well as satisfaction with health did not change significantly. Patients who had changed therapy (37% of the cohort) still had a reduced physical HRQoL (p=0.022) as well as significantly more depressive symptoms (p=0.010) and perceived their overall QoL as being worse (p=0.016). Conclusion Despite treatment many SpA patients have a reduced HRQoL and impaired sleep quality with significant differences between male and female patients. Impact of COVID19 pandemic was low. Table 1. Patient characteristics Total (n=314 ) Women n=142 (45.2% ) Men n=172 (54.8% ) p-value Age, years, mean (SD) 53.8 (13.9) 53.7 (14.5) 53.8 (13.4) 0.983 BMI, kg/m 2 , mean (SD) 27.3 (6.3) 27.1 (6.5) 27.4 (6.1) 0.706 Smokers, n (%) 68 (23.1) 34 (24.6) 34 (21.7) 0.544 HLA B27, n (%) (n=230) 120 (52.2) 46 (45.1) 54 (54.9) 0.055 CRP, mg/l, mean (SD) 6.14 (11.9) 5.88 (6.0) 6.37 (15.2) 0.721 Significant functional impairment, n (%) 54 (17.5) 29 (20.6) 25 (15.0) 0.198 Therapy, n (%) csDMARD 113 (36.2) 56 (39.7) 57 (33.3) 0.243 bDMARD 211 (67.4) 91 (64.1) 120 (70.2) 0.252 Depressive symptoms, n (%) Mild 109 (37.5) 53 (39.3) 56 (35.9) 0.040 Moderate/severe 48 (16.5) 27 (20.0) 21 (13.5) WHO-QOL mean (SD) Physical 60.2 (19.4) 57.4 (19.7) 62.6 (19.0) 0.019 Mental 67.7 (17.2) 64.5 (17.8) 70.3 (16.2) 0.003 Social 67.8 (20.0) 67.4 (19.6) 68.2 (20.3) 0.703 Environmental 77.3 (13.3) 76.6 (13.6) 78.0 (13.1) 0.363 Sleep, n (%) Abnormal sleep behaviour 138 (46.5) 76 (55.1) 62 (39.0) 0.006 Inability to sleep through the night 145 (49.4) 76 (55.1) 69 (44.2) 0.024 Waking too early 89 (30.4) 43 (31.4) 46 (29.5) 0.459 Need for sleeping pills 18 (6.1) 11 (8.0) 7 (4.4) 0.133 Unrefreshing sleep most or all nights 35 (11.9) 24 (17.5) 11 (7.0) &lt;0.001 Figure 1. Female SpA patients have increased depressive symptoms and a reduced HRQoL. Disclosure of Interests Natalie Frede Grant/research support from: Novartis study grant, Eva Rieger: None declared, Raquel Lorenzetti Grant/research support from: Novartis study grant, Ana Venhoff: None declared, Carolin Hentze: None declared, Ilona Jandova: None declared, Cornelia Glaser: None declared, Jens Thiel Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB, Consultant of: Novartis, AbbVie, Pfizer, BMS, UCB, Grant/research support from: BMS, Novartis study grants, Reinhard Voll Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB, Consultant of: Novartis, AbbVie, Pfizer, BMS, UCB, Lilly, Grant/research support from: Novartis study grant, Nils Venhoff Speakers bureau: Novartis, AbbVie, Pfizer, BMS, UCB, Consultant of: Novartis, AbbVie, Grant/research support from: Novartis study grant